Incidence of varicella in children in Jeju-do, Korea, 2005-2016: age-period-cohort analysis

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Abstract

OBJECTIVES

Although the nationwide inoculation rate of varicella vaccine was approximately 95% in Korean children recently, the number of notified varicella cases is unexpectedly continuously increasing till now. To suggest some hypotheses regarding this discrepancy, an age-period-cohort (APC) analysis as a descriptive epidemiology study was conducted for children residing in Jeju-do, Korea.

METHODS

The raw data were obtained from the nationwide database for insurance claim of healthcare fee provided by the National Health Insurance Service, Korea. The selection criteria were children aged 2-13 years who visited any healthcare center due to varicella from 2005 to 2016 while residing in Jeju-do. After calculating the birth cohort-specific crude incidence rates by age and year, the intrinsic estimator method was used to perform the APC analysis.

RESULTS

As the annual crude incidence rates decreased with increasing age between 2005 and 2016, the age and period effects also decreased. The intrinsic estimator coefficients suggesting the cohort effect shifted from positive to negative in 2011, the starting year of free varicella vaccine program in Jeju-do.

CONCLUSIONS

The results suggested that inoculated varicella vaccines have preventive effects. However, further studies to evaluate waning immunity would be needed.

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Most cited references 26

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Global Varicella Vaccine Effectiveness: A Meta-analysis.

Mona Marin, Melanie Marti, Anita Kambhampati … (2016)

Several varicella vaccines are available worldwide. Countries with a varicella vaccination program use 1- or 2-dose schedules.

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Ten year follow-up of healthy children who received one or two injections of varicella vaccine.

Barbara Kuter, , Jonathan Hartzel … (2004)

The rate of varicella and persistence of varicella antibody after a one dose vs. a two dose regimen of varicella virus vaccine live Oka/Merck (VARIVAX; Merck & Co., Inc., West Point, PA) in approximately 2000 children were compared during a 9- to 10-year follow-up period. Children 12 months to 12 years of age with a negative history of varicella were randomized in late 1991 to early 1993 to receive either one or two injections of varicella vaccine given 3 months apart. Subjects were actively followed for varicella, any varicella-like illness or zoster and any exposures to varicella or zoster on a yearly basis for 10 years after vaccination. Persistence of varicella antibody was measured yearly for 9 years. Most cases of varicella reported in recipients of one or two injections of vaccine were mild. The risk of developing varicella >42 days postvaccination during the 10-year observation period was 3.3-fold lower (P < 0.001) in children who received two injections than in those who received one injection (2.2% vs. 7.3%, respectively). The estimated vaccine efficacy for the 10-year observation period was 94.4% for one injection and 98.3% for two injections (P < 0.001). Measurable serum antibody persisted for 9 years in all subjects. Administration of either one or two injections of varicella vaccine to healthy children results in long term protection against most varicella disease. The two dose regimen was significantly more effective than a single injection.

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Loss of vaccine-induced immunity to varicella over time.

Rachel Civen, Jane F Seward, Dalya Guris … (2007)

The introduction of universal varicella vaccination in 1995 has substantially reduced varicella-related morbidity and mortality in the United States. However, it remains unclear whether vaccine-induced immunity wanes over time, a condition that may result in increased susceptibility later in life, when the risk of serious complications may be greater than in childhood. We examined 10 years (1995 to 2004) of active surveillance data from a sentinel population of 350,000 subjects to determine whether the severity and incidence of breakthrough varicella (with an onset of rash >42 days after vaccination) increased with the time since vaccination. We used multivariate logistic regression to adjust for the year of disease onset (calendar year) and the subject's age at both disease onset and vaccination. A total of 11,356 subjects were reported to have varicella during the surveillance period, of whom 1080 (9.5%) had breakthrough disease. Children between the ages of 8 and 12 years who had been vaccinated at least 5 years previously were significantly more likely to have moderate or severe disease than were those who had been vaccinated less than 5 years previously (risk ratio, 2.6; 95% confidence interval [CI], 1.2 to 5.8). The annual rate of breakthrough varicella significantly increased with the time since vaccination, from 1.6 cases per 1000 person-years (95% CI, 1.2 to 2.0) within 1 year after vaccination to 9.0 per 1000 person-years (95% CI, 6.9 to 11.7) at 5 years and 58.2 per 1000 person-years (95% CI, 36.0 to 94.0) at 9 years. A second dose of varicella vaccine, now recommended for all children, could improve protection from both primary vaccine failure and waning vaccine-induced immunity. Copyright 2007 Massachusetts Medical Society.

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Author and article information

Journal

Journal ID (nlm-ta): Epidemiol Health

Journal ID (iso-abbrev): Epidemiol Health

Journal ID (publisher-id): EPIH

Title: Epidemiology and Health

Publisher: Korean Society of Epidemiology

ISSN (Electronic): 2092-7193

Publication date Collection: 2018

Publication date (Electronic): 8 November 2018

Volume: 40

Electronic Location Identifier: e2018054

Affiliations

[1 ]Jeju Center for Infection Control, Jeju, Korea

[2 ]Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea

Author notes

Correspondence: Jong-Myon Bae Department of Preventive Medicine, Jeju National University School of Medicine, 102 Jejudaehak-ro, Jeju 63241, Korea E-mail: jmbae@ 123456jejunu.ac.kr

Author information

Jinhee Kim http://orcid.org/0000-0003-1629-9812

Ji-Eun Kim http://orcid.org/0000-0003-2845-3282

Jong-Myon Bae http://orcid.org/0000-0003-3080-7852

Article

Publisher ID: epih-40-e2018054

DOI: 10.4178/epih.e2018054

PMC ID: 6302224

PubMed ID: 30428643

SO-VID: 8c2fe15c-7abe-4e87-b919-bff023cc75ad

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Incidence of varicella in children in Jeju-do, Korea, 2005-2016: age-period-cohort analysis

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Abstract

OBJECTIVES

METHODS

RESULTS

CONCLUSIONS

Related collections

Chinese Journal of School Health

Most cited references 26

Global Varicella Vaccine Effectiveness: A Meta-analysis.

Ten year follow-up of healthy children who received one or two injections of varicella vaccine.

Loss of vaccine-induced immunity to varicella over time.

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